Need To Redo BA w/ Silicone After Bottoming Out, Any Advice? (photo)

I had my BA two months ago. (330, silicone, super high profile, submuscular, infra) Now I know my breasts have bottomed out. The doctor said he would expand the pocket (upper pole) and he could take some skin bellow the niples too. Since the silicone is lower than the position it should be, if takes off this skin, the breast will go down instead of the silicone going up, Am I wrong??? What should be done so it would look better??

Doctor Answers 5

Bottoming out after augmentation

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Based on your photos, I agree that your left implant has bottomed out. You may see a worsening of the implant position over the next 3 months as the breast continues to evolve. This will require an inferior capsulorrhaphy to tighten the pocket and hold the implant up. If your capsule is thin, reinforcing the capsule repair is helpful to prevent recurrence. I don't use Strattice for these types of cases anymore, having switched to SERI. (It is better tolerated and much easier to work with). At the same time a capsulorrhaphy is done, it can be helpful to perform a "mirror capsulotomy" to open the pocket opposite the capsulorrhaphy so the implant has room to move in the right direction. 

I don't believe you need any skin removal, simply a repositioning if your implant. 

Advice for correcting bottoming out implants

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There are many factors that can contribute to implants bottoming out, which is when they settle too low. What all factors have in common is that the tissues on the lower part of the bresat are not adequate to support the implants. Paradoxically, going under the muscle can make it worse since the muscle pushes down from above but doesn't add support from below. What I see in the pictures is a very tight skin envelope relative to the size of the implants so it will be wise to heal some more before having another procedure. You may benefit from a Strattice garft for a living internal bra.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Revision breast augmentation

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Thanks for the question and the pictures.  It appears that you have bottoming out and this requires surgical intervention to repair.  In addition to suture techniques which close the inferior aspect of the pocket to push the implant back up into its proper position, I often use Strattice.  It's a collagen matrix that provides a great deal of strenght to the repair.

You may want to wait a few months to allow for the swelling to decrease a little more, and the capsule to form a bit more in order to have the best tissue to repair.  In the meantime, wear a supportive bra to prevent further downward movement.

I hope this helps.

Bottoming out

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The photos are not that conclusive, but if you do have bottoming out, then the support along the fold has been compromised and would need to be corrected often with suture techniques and capsule manipulation.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Bottoming Out Correction?

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Thank you for the question and pictures.

Bottoming out involves inferior migration of the implants. This causes the nipple areola complex to appear too high on the breasts. Also, the distance from the areola to the inframammary fold is too great.

In my opinion,  bottoming out his best corrected by “raising” the inframammary fold using internal sutures ( interior capsulorrhaphy). This is done after careful measurements are made from the areola to the “new” inframammary fold.  Removal of skin below the areola is not necessary  in my opinion.

I would suggest  that you  confirmed  that your surgeon  has had significant success in the past with similar patients.

I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.